HAG联合地西他滨治疗骨髓增生异常综合征临床效果及安全性分析

目的 探讨高三尖杉酯碱+阿糖胞苷+粒细胞集落刺激因子(HAG)联合地西他滨治疗骨髓增生异常综合征临床效果并对安全性进行评价.方法 86例骨髓异常增生综合征患者随机分为HAG组和联合组,每组43例.HAG组采用高三尖杉酯碱静脉滴注,1 mg/d,1次/d,阿糖胞苷静脉滴注,2 mg/kg,1次/d,粒细胞集落刺激因子300 μg/d,静脉滴注,1次/d,3种药物均连续使用14 d.联合组在HAG组治疗基础上加用地西他滨,静脉滴注,15 mg/m2,连续输注3 h以上,每8 小时1次,连用3 d.观察2组患者治疗前后血管内皮生长因子、白细胞、血小板和血红蛋白水平;观察2组不良反应发生情况及复发率;随访至2016年1月,观察2组总体生存时间和无病生存时间,并绘制生存曲线.结果 2组治疗后血管内皮生长因子、白细胞、血小板和血红蛋白水平均显著高于治疗前,且联合组高于HAG组,差异均有统计学意义(P<0.05).联合组疗效优于HAG组,差异有统计学意义(U=2.118,P<0.05).联合组完全缓解率和总有效率明显高于HAG组,差异有统计学意义(P<0.05).2组血小板减少、腹泻、肝功能损伤发生率比较,差异无统计学意义(P<0.05).联合组肺部感染、恶心呕吐、发热的发生率明显高于HAG组,复发率明显低于HAG组,差异均有统计学意义(P<0.05).随访至2016年1月,HAG组死亡14例,联合组死亡6例,联合组总体生存时间和无病生存时间显著高于HAG组,差异有统计学意义(P<0.05).结论 HAG联合地西他滨治疗骨髓增生异常综合征可以显著改善患者血管内皮生长因子和相关血细胞水平,延长患者生存时间,降低病死率,临床效果显著.

Therapeutic effects and safety of HAG combined with decitabine on myelodysplastic syndrome

Objective To investigate the therapeutic effects of homoharringtonine+aracytidine+granulocyte colony-stimulating factor (HAG) combined with decitabine on myelodysplastic syndrome, and to evaluate its safety.Methods Eighty-six patients with myelodysplastic syndrome were randomly divided into HAG group and combination treatment group,with 43 patients in each group.The patients in HAG group were treated with homoharringtonine by intravenous drip, 1mg/d, 1 time/d, aracytidine by intravenous drip,2mg/kg,1 time/d,granulocyte colony-stimulating factor by intravenous drip,300g/d,1 time/d, for 14 days.However,the patients in combination treatment group,on the basis of HAG group,were treated with decitabine by intravenous infusion, 15mg/m2,continuous infusion for 3 hours or more,1 time/8 hours,for 3 days.The changes of vascular endothelial growth factor, white blood cell,platelet and hemoglobin levels were observed before and after treatment,moreover, the incidence rate of adverse reactions and relapse rate were observed and compared between two groups.The patients in both group were followed up until January 2016,and the overall survival time and disease free survival time were observed,besides, the survival curve was drawn.Results After treatment the levels of vascular endothelial growth factor,white blood cell,platelet and hemoglobin in both groups were significantly higher than that before treatment,moreover, which in combination treatment group were significantly higher than those in HAG group (P<0.05).The therapeutic effects in combination treatment group were superior to those of HAG group (U=2.118,P<0.05).The complete remission rate and total effective rate in combination treatment group were significantly higher than those in HAG group (P<0.05).However there were no significant differences in the incidence rates of thrombocytopenia,diarrhea,liver function injury between two groups (P>0.05).After follow-up till January 2016,14 patients died in HAG group, however,only 6 patients died in combination treatment group.Moreover the overall survival time and disease-free survival time in combination treatment group were significantly higher than those in HAG group (P<0.05).Conclusion The HAG combined with decitabine in treatment of myelodysplastic syndrome can significantly improve the levels of vascular endothelial growth factor and related blood cells,prolong the survival time of patients,reduce death rate,with obvious clinical effects.